NCM 112 Lec - Respi System

Upper Respiratory Tract

Filters, warms, and humidifies incoming air before it reaches the lungs.

Nose and Nasal Cavities

Primary entry point; lined with mucous membranes and cilia to trap debris.

Paranasal Sinuses

Four pairs of air-filled cavities (frontal, ethmoid, sphenoid, maxillary) that lighten skull weight and resonate voice.

Frontal, Ethmoid, Sphenoid, and Maxillari Sinuses

The 4 Paranasal Sinuses

Pharnyx

Divided into nasopharynx, oropharynx, and laryngopharynx; serves as a shared pathway for air and food.

Larynx

Connects the pharynx to the trachea. Houses the vocal cords and the epiglottis, a flap of cartilage that prevents food/fluid aspiration into the airway during swallowing.

Lower Respiratory Tract

Responsible for gas conduction and alveolar gas exchange.

Trachea or Windpipe

Cartilaginous tube extending from the larynx into the thoracic cavity, bifurcating at the carina into the right and left mainstem bronchi.

Carina

Point at which the trachea bifurcates (divides) into the left and right mainstem bronchi.

Bronchial Tree

Branches sequentially into secondary (lobar) bronchi, tertiary (segmental) bronchi, subsegmental bronchi, and bronchioles.

3 Lobes

How many lobes does the Right Lung has?

2 Lobes

How many lobes does the left lung has?

Cardiac Notch

The left lung has 2 lobes only because of the presence of?

Alveoli

Microscopic air sacs surrounded by pulmonary capillaries where actual gas exchange occurs.

Ventilation

The physical act of moving air back and forth through the airways.

Inhalation and Exhalation

Key mechanisms of Ventilation

Oxygenation

The physiological process of getting oxygen molecules across the alveolar-capillary membrane, binding them to hemoglobin, and delivering them to body tissues.

Diffusion

Key mechanism of Oxygenation where it does this across the alveoli into the RBCs

Occupational Lung Disease

Males have a higher rate of developing?

Pack-Years and E-cigarretes, 2nd hand smoke, exposure, and drug use

The information we need from the patient about their lifestyle and smoking history

Home Heating source, mold, dampness, dander, and location

The information we need from a patient in their environment & living conditions.

Patient's Own Words

The chief complaint is record in the?

Provokes/Palliates/Onset

What brings on the breathing difficulty? What makes it better (e.g., sitting up, rest) or worse (e.g., cold air, exercise)?

Quality/Quantity

Describe the cough/dyspnea (e.g., tight chest, suffocating feeling, dry vs. productive cough).

Region/Radiation

Where is the pain or tightness located? Does it radiate to the shoulder, jaw, or back?

Severity

Rate dyspnea or pain on a 0-10 scale. Use functional indicators (e.g., "How many steps can you walk before stopping to catch your breath?")

TIming/Frequency

Sudden onset vs. gradual onset. Is it worse at night

Understanding

What does the patient think is happening?

Risk for DVT

Recent major surgeries are asked to the patient because they are at higher risk for?

Allergies

Asked to counter-check drugs and be given ANST

Aspirin or NSAIDs

can trigger bronchospasm in aspirin-exacerbated respiratory disease

Prior Intubations/ICU Admission

Crucial indicator of respiratory disease severity (e.g., "Have you ever been on a mechanical ventilator or spent time in the ICU for your breathing?").

Family History

Genetically linked or transmissible respiratory disorders within immediate family members are asked when getting?

Occupational History

The work environment is asked to know exposures that contribute to occupational lung diseases (pneumoconiosis).

Mesothelioma

a rare and aggressive cancer that forms in the mesothelium, which is the protective tissue lining your lungs, abdomen, heart, and testicles due to the exposure to ASBESTOS

Silicosis

Developed due to the exposure to silica dusy

Black Lung

Common for someone working with coal dust

Lisinopril

An ACE inhibitor that can cause a chronic, dry, persistent cough

Non-Selective Beta Blockers

Can induce bronchospasm in asthmatic patients (propanolol).

1. Dyspnea

2. Cough

3. Hemoptysis

4. Wheezing

5. Chest Pain

6. Sputum Production

6 Common signs and symptoms of respiratory diseases

Dyspnea

A subjective feeling of difficult, uncomfortable, or labored breathing.

Exertional Dyspnea

Occurs only during physical activity (common in early COPD or Heart Failure).

Orthopnea

Inability to breathe comfortably while lying flat; measured by the number of pillows needed (e.g., "2-pillow __________").

Paroxysmal Nocturnal Dyspnea (PND)

Sudden awakening from sleep gasping for air

Cough

A protective reflex mechanism that clears the tracheobronchial tree of secretions, foreign bodies, or irritants

Dry/Non Productive

Often caused by viral upper respiratory infections, early asthma, ACE inhibitors, or interstitial lung disease.

Productive Cough

Associated with mucus production (pneumonia, chronic bronchitis).

Morning Cough

Typical in smokers or patient's with COPD

Nighttime Cough

Common in Asthma or heart failure

Sputum Production

Matter discharged from the respiratory passages (mucus, pus, or blood)

Clear / White Sputum

Normal, viral infection, or asthma

Yellow / Greem Sputum

Bacterial infection (e.g., pneumonia, acute bronchitis)

Rusty / Red Brown

caused by Streptococcus pneumoniae or pneumococcal pneumonia.

Pink-Frothy

Suggests pulmonary edema, an acute emergency

Foul-smelling (Foetid)

Lung abscess or anaerobic infection

Hemoptysis

xEpectoration of blood or blood-streaked sputum arising from the lower respiratory tract.

Hemoptysis (2)

bright red, alkaline, frothy blood mixed with sputum

Hematemesis

vomited blood: dark red, acidic, "coffee-ground" appearance

Wheezing

A high-pitched, musical adventitious breath sound caused by air rushing through narrowed or obstructed airways.

Expiration

Wheezing is commonly head during __________ but can occur in inspiration as well

Severe Obstruction

Wheezing can occur at inspiration if the patient has?

Chest Pain

Pain originating from the pleura, chest wall, or mediastinal structures.

Pleuritic Chest Pain

Sharp, stabbing pain that worsens with deep inspiration, coughing, or sneezing. Caused by inflammation of the pleural layers rubbing together (e.g., Pleurisy, Pneumonia, Pulmonary Embolism, Pneumothorax).

Cardiac Causes

When the patient has chest pain, always rule out?

Pulmonary Function Test

Is a group of non-invasive breathing tests that measure how well your lungs work.

● These tests evaluate lung volume, airflow speed, and gas exchange efficiency to help doctors diagnose and monitor respiratory conditions like asthma and COPD

Obstructive vs Restrictive

Pulmonary Function Tests identifies?

Obstructive Disease

The patient cannot get air OUT (Exhalation problem due to narrow or collapsed airways).

Restrictive Disease

The patient cannot get air IN (Inhalation problem due to stiff lungs or a restricted chest wall).

Spirometry

Measures how much air you can breathe out and how fast you can empty your lungs.

Lung Volume Test

Uses an airtight booth (body plethysmography) to measure total lung capacity and leftover air.

Body Plethysmography

measures thoracic volume and airway resistance plus total lung capacity and residual air

Diffusion Capacity or DLCO

Evaluates how efficiently oxygen transfers from your air sacs into your bloodstream

Bronchodilators

Hold __________ when doing Pulmonary Function tests as this hinder readings.

4-6 hours

When measuring a patient's pulmonary lung function, instruct them to avoid cigarettes or e-cigs for at least?

2 hours

Tell the patient to skip heavy meals _________ before pulmonary lung function as it promotes diaphragm restriction.

Myocardial Infarction

When the patient had _________ within 1 MONTH, Pulmonary Lung Function is contraindicated

Severe Chest/Abdominal Pain and Recent Eye surgery

Other than MI, if the patient has these, DON'T perform Pulmonary function test

at least 6 seconds

In spirometry, instruct the patient to blast air out with force for at least?

Nose clip

Put also a _______ in the patient's nose to precent air leaks.

Claustrophobia

When doing lung volume testing, a patient with __________ can develop severe anxiety which can disrupt results

Panting Breaths

Instruct the patient to do gentle and shallow _____________ when measuring their lung volume using a plethysmograph.

10 seconds

For the diffusion capacity, instruct the patient to hold their breath for exactly ___________ upon inhaling the tracer gas

High Fowler

After measuring the patient's pulmonary function, put them on _________ position until their breathing pattern returns to baseline.

Water

Provide ________ to relive oral dryness or throat irritiation after rapid exhalation

Pulse Oximetry

a noninvasive, continuous method of monitoring the oxygen saturation of hemoglobin.

Poor Peripheral Circulation

Cold fingers, severe hypotension (low blood pressure), or Raynaud's phenomenon limit pulse detection.

Dark Nail Polish or Artificial air

Blocks light transmission through the nail bed.

Skin Pigmentation or Anemia

Can cause subtle variations or overestimations depending on device calibration when using pulse oxi

Chest X-ray

In medical-surgical settings, a _____________ is routinely ordered to:

● Diagnose Respiratory Conditions

● Evaluate Cardiac Status

● Verify Invasive Device Placement

Chest X-ray (2)

Low resolution. Small lung nodules or deep tissue structures can be hidden behind bones or heart tissue due to 2D overlap

Chest CT-scan

Rotates an X-ray source around the body to take hundreds of thin cross-sectional images ("slices"), which a computer reconstructs into a 3D volume

Chest CT SCan (2)

● Evaluating suspicious spots or nodules found on a standard X-ray.

● Diagnosing pulmonary embolism (blood clots in lungs using CT Angiography).

● Staging lung cancer and examining complex trauma (rib fractures, lung contusions).

● High-resolution monitoring of chronic lung diseases (COPD, pulmonary fibrosis).

Ionizing Radiation

Chest CT Scan is better than CXR but exposes the patient to a higher dose of?

Chest MRI

Uses powerful magnets and radio waves to align hydrogen atoms in the body, capturing detailed signals from water- and fat-rich tissues without radiation

Chest MRI (2)

● Evaluating tumors invading the chest wall, brachial plexus (nerve network), or spine.

● Detailed assessment of mediastinal masses (space between lungs) or heart and major vessel structures.

● Preferred option when detailed soft-tissue imaging is required for pregnant patients or pediatric cases

Zero Radiation

Chest MRI is preferred for Pregnant and pediatric patients because it has?

Motor Sensitivity

Chest MRI has __________ that can blur out some details esp. when breathing

Metal Implants

Chest MRI is unusable for patients with _______ due to it being highly magnetic

Arterial Blood Gas

Evaluates a patient's oxygenation, ventilation, and acid-base balance using blood drawn directly from an artery (usually the radial artery in the wrist)

Allen's Test

Done before withdrawing blood to be used for ABG Analysis. It ensures collateral circulation in which the Ulnar Artery can adequately supply blood to the distal fingers when the Radial artery is not functioning.